Fortune E Charles, Mercado Catherine E, Drew Peter A, Morris Christopher G, Amdur Robert J
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, United States.
Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, United States.
Rep Pract Oncol Radiother. 2022 Mar 22;27(1):121-124. doi: 10.5603/RPOR.a2022.0010. eCollection 2022.
In patients with well-differentiated thyroid cancer, there is controversy about the prognostic importance of a large number of positive neck nodes and the potential value of radioiodine therapy. The purpose of this study was to evaluate this issue in the group of patients for whom it is most clinically important - those with classic histology and favorable T and M stage.
Twenty-five patients met the following inclusion criteria: classic histology of papillary or follicular thyroid carcinoma treated with total thyroidectomy and neck dissection followed by adjuvant I-131 treatment in our department between January 1, 2003, and December 31, 2013; adult age of > 21 years; and American Joint Committee on Cancer (AJCC ) stage (8 edition) of T0-3, N1b with ≥ 5 positive nodes, and M0.
The median positive node number was 10 (range, 5-31). The median adjuvant I-131 dose was 158 mCi (range, 150-219 mCi). The median follow-up in patients without recurrence after treatment was 7.3 years. The 10-year actuarial rates were favorable: overall survival, 100%; freedom from visible recurrence, 82%; and visible or biochemical recurrence, 72%.
Recurrence was infrequent in our study population with ≥ 5 positive nodes following moderate-dose adjuvant I-131 treatment. These results are valuable in directing initial adjuvant therapy and follow-up intensity. Our results do not inform the question of the use of postoperative thyroglobulin (Tg) level to select N1b patients for low-dose I-131 treatment.
在高分化甲状腺癌患者中，大量阳性颈部淋巴结的预后重要性以及放射性碘治疗的潜在价值存在争议。本研究的目的是在临床意义最为重大的患者群体——具有经典组织学特征且T和M分期良好的患者中评估这一问题。
25例患者符合以下纳入标准：2003年1月1日至2013年12月31日期间在我科接受全甲状腺切除术和颈部清扫术，随后接受辅助性I-131治疗的乳头状或滤泡状甲状腺癌经典组织学类型患者；年龄大于21岁；美国癌症联合委员会（AJCC）第8版分期为T0-3、N1b且阳性淋巴结≥5个、M0。
阳性淋巴结数中位数为10个（范围5-31个）。辅助性I-131剂量中位数为158 mCi（范围150-219 mCi）。治疗后无复发患者的中位随访时间为7.3年。10年精算率良好：总生存率为100%；无可见复发率为82%；可见或生化复发率为72%。
在我们的研究人群中，接受中等剂量辅助性I-131治疗且阳性淋巴结≥5个的患者复发并不常见。这些结果对于指导初始辅助治疗和随访强度具有重要价值。我们的结果未涉及使用术后甲状腺球蛋白（Tg）水平来选择N1b患者进行低剂量I-131治疗的问题。
